Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1184119208 |
---|---|
Provider Name | Douglas Wentworth |
First Address | Webster, MA 01570-3417 |
Second Address | Webster, MA 01570-3417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2018 |
Last Update Date | 30/06/2018 |